Fractures wa humerus ndi kusamutsidwa ndi popanda kukondera

Malinga ndi kafukufuku zowerengera, 7% ya fractures a nkhani humerus chifukwa. kuwonongeka ofanana uka makamaka chifukwa mathithi ndi nkhonya. Fractures wa humerus mwina m'madera osiyanasiyana a izo, zomwe limodzi ndi zizindikiro zosiyanasiyana ndipo nthawi zina pamafunika njira osiyana mankhwala.

Kapangidwe anatomical

Humerus lagawidwa zitatu mbali: thupi kapena diaphysis - ndi gawo pakati, ndi malekezero otchedwa epiphyses. Malinga ndi malo kuwonongeka zikusonyeza fractures a pamwamba, pakati kapena kuchepera humerus. Chigawo chapamwamba umatchedwanso proximal ndi wapotalikira kuitana m'munsi. Diaphysis anawagawa magawo: chapamwamba, pakati ndi kutsikira.

Nawonso epiphyses ndi dongosolo zovuta, popeza ali nawo m'gulu zimfundo ndi kusunga minofu. Mu kumtunda kwa humerus mutu ndi semicircular anatomical khosi - m'dera yomweyo pansi mutu. Iwo articular pamwamba pa tsamba mbali ya olowa phewa. awiri timabamputimabampu, zimene kuphatikana minofu ili m'munsimu khosi anatomic. Kuwatcha timabamputimabampu yaikuluikulu. Komabe fupa zina itsekeke pang'ono, kupanga otchedwa phewa khosi opaleshoni. M'munsi humerus anapambulwa umaimiridwa ndi pamalo awiri olowa: a cheza fupa mkono linanena mutu condyle ndi mawonekedwe anamaliza ndi kumabweretsa ulnar chipika humerus.

The mitundu ikuluikulu ya fractures

Gulu la fractures imachitika mu njira zingapo. Pa dzanja limodzi, humerus fractures m'magulumagulu ndi malo, mwachitsanzo. E. Dipatimenti. Choncho, akutali wovulala:

- mu proximal ndi (kumtunda) gawo;

- diaphysis (pakati gawo);

- mu wapotalikira (m'munsi) gawo.

Poyankha, makalasi izi akupitiriza unagawika mitundu. Komanso, wovulala angayambe malo osiyanasiyana mkati khadi limodzi kapena oyandikana.

Komano, akhoza kugawidwa kuwonongeka kwa fractures ndipo popanda kuchepetsa, ndi kuonetsetsa unagawanika (comminuted) fractures. kusiyana A ndi zoopsa lotseguka (choipa ndi minofu zofewa ndi khungu) ndi chatsekedwa. Pa nthawi yomweyo mu moyo lolamuliridwa ndi m'mbuyomu.

Mfundo za mtundu wa wovulala ndi dipatimenti

Zinthu zinasintha mu gawo proximal akhoza kugawidwa mu kwapakati pa-articular kapena articular. Ndi intraarticular (nadbugorkovom) mutu wokha kapena khosi anatomical fupa mwina imawonongeka. Articular wovulala lagawidwa tubercle wa humerus ndi wovulala khosi opaleshoni ya chachikulu.

Ngati kuwonongeka diaphysis komanso secrete subspecies zingapo: wovulala chapamwamba lachitatu, pakati kapena pansi. Mofanana kwambiri ndi chikhalidwe cha wovulala: scythe, mtanda, mwauzimu, comminuted.

Wapotalikira Angagwiritsidwenso amakhudzidwa mosiyanasiyana. Tingasiyanitsire articular supracondylar wovulala, ndi fractures wa condyles ndi midadada amene kwapakati pa-articular. Gawo chozama chimasiyanitsa flexor ndi extensor supracondylar ndi transcondylar, intercondyloid Y kapena T-mphako ndi akutali wovulala condyles.

kuwanda

Tsiku ndi tsiku chifukwa mathithi n'kuliza makamaka anakhudzidwa kumtunda kwa khosi opaleshoni, wachitatu pakati diaphysis kapena epicondyles mmunsi mwa humerus lapansi. fractures pakanema amachuluka, koma nthawi zambiri kuchepetsa. Iwo ayenera kukumbukira kuti pakhoza pamodzi pa yomweyo mitundu yambiri ya fractures (zambiri mkati dipatimenti limodzi).

Wovulala mutu humeral, ndi anatomical ndi opaleshoni khosi ndi achikulire kawirikawiri. Chigawo m'munsi kawirikawiri akulephera ana pambuyo kugwa zoipa: fractures intercondylar ndi transcondylar ali sizachilendo. thupi fupa (diaphysis) atengeke fractures zambiri zokwanira. Yak pa zotsatira pa phewa, komanso mathithi pa chigongono kapena mkono anaweramuka.

Fractures a mbali proximal

Pakuti kwapakati pa-articular wovulala monga mutu humeral ndi Chilwa kumbuyo khosi lake anatomical. Mbali yoyamba mwina comminuted wovulala kapena dislocation Komanso anati. Ngati chachiwiri akhoza inagunda wovulala pamene otlomok anatomical khosi anadzetsa mutu komanso akhoza kuwononga izo. Mu mwachindunji-ntchito choipa otlomok akhoza unagawanika, koma wopanda chidwi kuchepetsa.

Komanso, kuwonongeka kwa mbali proximal la fupa lothyoka la zikuphatikizapo tuberosity wamkulu wa humerus ndi zazing'ono: chrezbugorkovye detachments ndi tokhala. iwo akhoza kukhala si kugwa pa phewa lake, koma pamene kwambiri mwadzidzidzi minofu chidule. Wovulala ndi tubercle wa humerus akhoza limodzi ndi kugawikana kwambiri popanda kusamutsidwa makombo kapena kupita izo pansi ndondomeko akromedialny kapena pansi ndi outwards. kuwonongeka amenewa kumachitika pamene zoipa mwachindunji kapena dislocation wa paphewa.

Ambiri ndi wovulala khosi opaleshoni ya paphewa. chifukwa nthawi zambiri amakhala dontho. Ngati dzanja nthawi kuvulazidwa anapatsidwa kapena kupatsidwa, ndiye mulembe adduktsionny atigwira kapena fupa wovulala, inagunda wovulala zingachitike ndi avareji malo komaliza pamene mpukutu wapotalikira anadzetsa gawo chapamwamba.

The wovulala akhoza kukhala imodzi mwa malo angapo. Bone ndiye ogaŵikana zidutswa ziwiri ndi zinayi. Mwachitsanzo, anatomical khosi wovulala akhoza limodzi ndi kulekana kwa munthu kapena timabamputimabampu onse wovulala opaleshoni khosi wovulala lowonjezera mutu ndi T. D.

Zizindikiro za wovulala mu gawo chapamwamba phewa

Kwapakati pa-articular wovulala dipatimenti limodzi ndi edema kapena magazi mu olowa. ukuwonjezeka zowoneka phewa mu Volume. Ndi kuthamanga chowawa pamutu. khosi la humerus wovulala amapereka ululu ndi mwaulesi zozungulira ndi kumverera. Pamene inagunda wovulala khosi opaleshoni za kayendedwe mu olowa phewa sangathe linaphwanya. Ngati pali kusamutsidwa, mwina kusintha olamulira a nthambi. M'dera la olowa n'zotheka magazi, kutupa, kapena chotupa. Pamene zikuoneka padziko phewa perednenaruzhnoy khalidwe Bony prominences akhoza kukamba za adduktsionnom kuchiyambi, ndipo ngati anaonekera Anabweza, ukuchitira umboni atigwira.

Komanso wovulala opaleshoni ya humerus akhoza kuchititsa pathological kuyenda. Fractures ndi kusamutsidwa lalikulu kapena kugawikana mwina angalepheretse kusuntha yogwira, ndipo ngakhale katundu ang'onoang'ono chitsulo chogwira matayala ndi kayendedwe chabe chifukwa kupweteka kwambiri. The owopsa ndiye chimake imene khosi humerus wovulala amapezeka ndi kuwonongeka zina, jamming, kukanikiza wa neurovascular mtolo. Akamalimbikira wa mtengo umenewu uwapangitsa edema, kuchepa tilinazo, venous stasis ndipo ngakhale ziwalo ndi paresis dzanja.

Wovulala ndi tuberosity wamkulu wa humerus amapereka ululu phewa, makamaka pamene dzanja lako m'malaya. Movement wa olowa phewa osweka kukhala okhumudwitsa.

Zizindikiro za diaphyseal wovulala

Fractures wa humerus m'dera diaphyseal ndi zofala. Pali kutupa, ululu, ndi uncharacteristic wa sayenda pa chotupa malo. Mapale chiyenera mu madera osiyana. Dzanja kayendedwe akuchitiridwa linaphwanya. N'zotheka kukha magazi. Fractures ndi kosangalatsa amphamvu Tingaone ngakhale ndi apoyera pa kupsyinjika phewa. Ngati mitsempha zozungulira chawonongeka, sikutheka kuwongola burashi ndi zala. Komabe, kuphunzira chikhalidwe cha kuwonongeka akusowa X-ray.

Fractures wa wapotalikira ndi zizindikiro zawo

Fractures wa wapotalikira ogaŵikana owonjezera articular (supracondylar extensor kapena flexor) ndi kwapakati pa-articular (condylar, transcondylar, fractures capitate kukwezedwa kapena chipika humerus). Chisokonezo dipatimenti imeneyi kuyambitsa mapindikidwe wa chigongono olowa. Komanso, pali ululu ndi kutupa, ndi kayendedwe n'zochepa ndiponso yopweteka kwambiri.

Supracondylar flexion zimachitika pambuyo kugwa pa dzanja wopindidwa, zikubweretsa kutupa kwa malo kuvulazidwa, ululu ndi kuonekera kwa maliseche diso kutalikitsa mkono wa. Extensor kuonekera pamene dzanja pererazognutosti mu kugwa, zowoneka kufupikitsa mkono ndi limodzi mwa ululu ndi kutupa. fractures otero angakhalenso pamodzi dislocation munthawi yomweyo olowa.

Kunja condyle fractures kaŵirikaŵiri zimayendera dontho pa lathyathyathya dzanja lotambasula kapena kupwetekedwa mwachindunji, ndipo yopuma zoweta ngati waponya pa mkono wake. Pali kutupa mu chigongono dera, ululu, ndipo nthawizina nuchoka kapena magazi mu olowa yokha. Movement pa chigongono okha, makamaka kukha magazi.

Capitate ukulu wovulala angayambe pamene kugwa pa mkono molunjika. Komanso okha kuyenda mu molumikizana mafupa ndi amayambitsa. Childs, izi ndi chatsekedwa wovulala humerus lapansi.

thandizo ndi diagnostics

Ngati mukukayikira wovulala nthambi ayenera bwino atathana kuteteza kuwonongeka kwa zinthu. Mukhozanso ntchito analgesics mpumulo ululu. Kenako, posachedwapa azibweretsa wozunzidwayo m'chipatala ndi matenda zolondola ndi thandizo la dokotala.

Kupeza Vuto akhoza wovulala pa zizindikiro zakumwamba, koma zotsatira komaliza akhoza zopezera pokhapokha radiography. Nthawi zambiri zithunzi zolosera osiyana pofuna kufotokozera chithunzi mokwanira. Fractures wa humerus nthawizina wonse anasonyezera ndiye kovuta kusiyanitsa ku sprains, mitundu ndi mikwingwirima, omwenso amafunika chithandizo chosiyana.

Chithandizo cha fractures zazing'ono

Wovulala humerus popanda kusamutsidwa amafuna immobilization chiwalo pulasitala kapena akuthawira basi. Zovuta n'zochepa kwambiri. Ngati pali pang'ono kukondera, izo imagwiridwa kuti muyike pena ndi immobilization wotsatira. Nthawi zina, unsembe wa splint zochotseka ndi chokwanira, mwa zina kujambula wathunthu chofunika.

fractures Minor mbali proximal kulola patapita masiku atatu kuti acite UHF ndi mankhwala maginito, ndipo pakutha masiku 7-10 kuyamba kukula kwa chigongono ndi dzanja mafupa, electrophoresis, UFO, kutikita ndi ultrasound kukhudzana. Patapita masabata 3-4 la pulasitala Longuet kapena clamps wapadera m'malo bandeji, kupitiriza mankhwala thupi ndi njira.

Kuchira osamukira zidutswa popanda opaleshoni

kuvulala More kwambiri monga wovulala kapena opaleshoni khosi wovulala ndi humerus ndi kusamutsidwa amafuna repositioning, pulasitala bandeji ndipo zonse x-ray m'chipatala. Pulasitala ungagwiritsidwe kwa masabata 6-8. M'pofunika kusuntha manja ndi zala kuchokera tsiku lotsatira patatha masabata 4, mukhoza kuchita kayendedwe chabe olowa phewa, akundithandiza wake wabwino, kupita kayendedwe yogwira. konzanso Komanso zikuphatikizapo mankhwala thupi, zofikisa, mechanotherapy.

Kufunika kwa alowererepo opaleshoni

Nthawi zina, repositioning n'zosatheka chifukwa cha kugawikana amphamvu kapena kungoti sapereka zotsatira ankafuna. Ngati pali wovulala ndi humerus mankhwala opaleshoni chofunika kukwaniritsa kuphatikiza zidutswa. Amphamvu kukondera, othyokathyoka kapena zosamveka wosakhazikika fupa lothyoka malo ayenera sizimene muyike pena ndi osteosynthesis ndi - kukonza wreckage masingano, zomangira, mbale. Mwachitsanzo, wovulala khosi humerus ndi kupezeka wathunthu makombo amafuna chikukonzekera mbale Kaplan-Antonov, masingano, kapena mtengo Vorontcova Klimov, pini kapena ndodo, n'kupeŵa zosayembekezereka ya kusamutsidwa okhota ndi msoko lapansi. Shards kusunga zomangira maphatikizidwe kapena Ilizarov. The tepi ndi chigoba samatha ntchito fractures zina zosamveka khadi m'munsi, kenako tayala ndi superimposed ndi unachitikira physiotherapy.

Fractures epicondyle popanda kusamutsidwa zimafunika kuvala pulasitala bandeji pa masabata 3. Kuchepetsa kungafune alowererepo pa opaleshoni. Condylar (intercondylar ndi transcondylar) fractures nthawi zambiri limodzi ndi kusamutsidwa a zotsala fupa ndi opareshoni. Muyike pena mu nkhani ino lotseguka kuonetsetsa kubwezeretsa kwa udindo lolondola la kali articular ndi kupanga osteosynthesis. Kenako ntchito mankhwala zobwezeretsa zovuta lapansi.

Chithandizo cha wovulala yovuta

Wovulala ndi humerus ndi kusamutsidwa, limodzi ndi kuwonongeka kwa mitsempha zozungulira, amafuna kufanana kwa zidutswa za mafupa ndi chithandizo ndiwofatsa ya mitsempha. Wovulala kuyenda womuyenerera mankhwala mankhwala kwa mitsempha akhoza buluzi yokha. Kenako kulumikiza mankhwala thupi ndi mankhwala thupi. Koma ngati mitsempha magwiridwe si kubwezeretsedwa m'miyezi yochepa, kenako opaleshoni imagwiridwa.

Mu Zikavuta kwambiri, pamene mafupa ndi ofunika kwambiri zosamveka makombo akhoza kuchotsedwa, kenako prosthesis ali wofunikila. Phewa olowa prosthesis ntchito m'malo mutu. Ngati kuwonongeka kwambiri hump minofu akhoza sutured mwachindunji humerus lapansi.

Chithandizo cha wovulala aliyense amafuna kutsatira malangizo onse akatswiri, komanso njira kwambiri konzanso. Immobilization ndi lopuma pamwamba kuonongeka kenako m'malo ndi katundu wina. Maphunziro a physiotherapy mankhwala thupi, kutikita ndi njira zofanana ndi kuperekedwa kangapo, ndi zina zosokoneza mpaka kuchira bwino. N'kofunikanso kuti chikumbumtima kukwaniritsa zofunika zonse konzanso kunyumba ndi kusamalira kukonzanso choipa.